PMS-Taming the raging monster
Most women suffer from PMS, or premenstrual syndrome, on a monthly basis, but what exactly is it and can we make the period before our period easier? Dr Sly Nedic
Premenstrual syndrome is so prevalent in modern women that it is now thought to be an expected and almost inevitable event prior to any menstrual cycle. More than 85% of women with periods suffer from PMS of varying severity.
In some cases, it presents as a premenstrual dysphoric disorder, which is the most severe and debilitating form of PMS. In addition to the troublesome symptoms caused by PMS, it is also often associated with crampy, heavy and painful periods.
This widespread incidence of intolerable PMS has driven many women to relieve their symptoms by thoughtlessly taking the contraception pill: “the one pill that fixes all”. By doing this, they actually mask the ‘message’ their bodies are trying to send them: there is a hormonal imbalance!
So, instead of finding the root cause of PMS, they tolerate some of the possibly less evident but nonetheless detrimental side effects of the pill. Can we blame them?
What is PMS?
Premenstrual syndrome refers to symptoms that may occur one to two weeks before a woman’s monthly menstruation. Symptoms may vary from period to period in the same individual related to type, severity, and variety.
Symptoms of PMS:
- Irritability and mood swings
- Tearfulness and crying spells
- Constipation or diarrhea
- Appetite changes or food cravings (sweets)
- Weight gain
- Trouble concentrating or memory problems
- Anxiety and depression
- Swollen/painful breasts
If women develop the premenstrual dysphoric disorder (PMDD), a severe form of PMS, symptoms can become harsher. PMDD is diagnosed when at least five of the following symptoms occur 7 to 10 days before the period, go away within a few days from the onset of the menstrual period, and affect a woman’s daily functioning:
- Severe mood swings
- Marked anger
- Decreased interest in usual activities/depressive mood
- Debilitating fatigue
- Physical problems, such as bloating and water retention
- Sugar craving
What causes PMS?
Integrative medicine always searches for the root cause of the problem. In PMS, the cause is often multifactorial.
Fluctuating hormones during the menstrual cycle are considered to be a primary cause of PMS. But what causes these common hormonal imbalances? First, there is an overwhelming amount of environmental toxicity, predominantly in the form of xenoestrogens, which disrupts our endocrine functions and interferes with our hormones, mainly estrogen.
Additionally, stress puts our bodies into fight-or-flight mode and can further influence the balance of hormones in our bodies. Other factors that contribute to hormone imbalances include junk food, insomnia, Wi-Fi and a sedentary lifestyle.
Another aspect to consider is nutritional deficiencies. Vitamins and minerals are important for the detoxification of hormones, particularly estrogens. When these are depleted, our bodies cannot compete with the high detoxification demand, thus causing estrogen dominance and, consequently, the symptoms of PMS.
The detoxification of hormones is further affected by the consumption of alcohol, which disrupts methylation processes for its own detoxification. Moreover, hormones and neurotransmitter functioning are linked. Thus, neurotransmitters such as serotonin and GABA contribute to anxiety, depression, irritability, and tension when there is a hormone imbalance. Hormones that always need to be checked in women struggling with PMS are estrogen, progesterone, thyroid and cortisol (covered in greater detail below).
A deficiency in the hormone progesterone is massively involved in the symptoms of moodiness, fluid retention and breast tenderness associated with PMS. Sufficient progesterone provides a calming and sedative effect during the premenstrual and menstrual period, and it is essential that its level balances that of estrogen – preventing estrogen dominance.
Progesterone and cortisol are both produced from a pro-hormone called pregnenolone. During times of stress, the body uses this pro-hormone for the production of cortisol at the expense of progesterone (a process called the pregnenolone steal). For this reason, it is essential to check progesterone levels in all women suffering from PMS and provide temporary support with bioidentical progesterone while aiming to eradicate excessive stress.
Estrogen imbalance is also involved in PMS pathology. Estrogen improves the mood and sleep, controls appetite (by upregulation of serotonin) and boosts the sex drive. It is produced during the first part of the menstrual cycle and must always be in balance with progesterone.
A balancing act
When estrogen levels are high in relation to progesterone, we develop symptoms of estrogen dominance, including PMS. Estrogen dominance is usually the result of environmental toxicity from xenoestrogens that compete with our body’s estrogen by biding to its receptors – a phenomenon often underestimated in women.
It is shocking that we put more than a hundred different toxins on our bodies every morning through the use of lotions and cosmetics containing parabens, phthalates, fragrances, and heavy metals, which act similarly to xenoestrogens – disrupting our endocrine functions and causing PMS symptoms – and yet we do not stop using them.
The detoxification of estrogens via the methylation process is so essential and requires adequate folate, vitamin B12, vitamin B6, zinc, magnesium, and choline.
Some women in searching for a ‘cure’ for PMS, mistakenly opt for self-medication, often resulting in an overload of vitamin B6, which has been falsely labeled as a good vitamin for PMS. However, recent studies showed concerns about the side effects of supplementation with vitamin B6, such as permanent nerve damage in women with daily doses in excess of 50 mg per day.
Furthermore, thyroid hormones have tight interactions with estrogen and progesterone and can cause a flare-up of PMS symptoms if low. Estrogen dominance affects thyroid functioning, decreasing its activity by up to 35%. Consequently, low thyroid functioning decreases progesterone levels. Low energy levels, increased anxiety, weight gain, and a sluggish metabolism are just some indications of thyroid hormone imbalances and must be checked during the diagnostic work-up of PMS. That obviously requires checking and supporting adequate nutrition for optimal thyroid functioning.
Finally, cortisol, as mentioned, has a significant effect on PMS. As the primary stress hormone, it affects both estrogen and progesterone by altering their levels. Besides decreasing progesterone via pregnenolone steal, high cortisol blocks progesterone receptors, blocking their activity and further contributing to PMS.
To fully understand what the root cause of PMS is in each Individual case, integrative medicine must take a personalized approach that includes balancing hormones, adequate nutrition plans and anti-stress interventions with the use of cortisol adaptogens, personalised exercise programs, and other methods.
References are available on request.